E-DRUG: Guidelines : Anti-infectious treatment duration: The SPILF and GPIP
French guidelines and recommendations
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1. English version
1.1. Introduction
Throughout the world, antibiotic resistance has become a major cause for
concern in public health; in this context, it is of key importance to reduce
treatment duration in view of limiting selection pressure on bacteria.
Shortened treatment presents other advantages including lowered costs, improved
medication compliance and reduced risk of adverse effects.
Few studies have specifically focused on treatment duration, and quite often,
their methodology has not been robust. Treatment duration determination should
result from prospective, comparative studies using the same molecule in two
groups and being systematically double-blinded when the effectiveness criteria
are far from robust (pain alleviation, reduced fever duration, tympan-related
aspects. . .).
Open studies are practicable in cases where the evaluation criteria are robust,
one example being bacteriological eradication. The most sensitive points in
these studies concern selection of relevant effectiveness criteria and
inclusion of a number of patients sufficient to demonstrate non-inferiority
while taking into account the proportion of spontaneous recoveries, which
frequently occur in community-acquired infections.
The SPILF recommendation group has been mandated by the learned society to
issue guidelines concerning the duration on antibiotic infection treatment in
town and hospital-based practices.
Only currently existing, non-complicated infections manifesting favourable
evolution will be taken into consideration.
On the other hand, some situations are not considered, particularly
material-related osteo-articular infections, the reason being that a
large-scale, randomized study comparing two treatment durations and soon to be
published shall necessitate the updating of existing guidelines. It is for
similar reasons that we have only rarely considered antifungal, anti-mycosis
and anti-parasite treatments, all of which necessitate specific guidelines.
Lastly, we have not dealt with infections with regard to which, no changes have
been noted since the publication in 2017 of an article proposing optimized
treatment durations [1]
the article:
https://www.sciencedirect.com/science/article/pii/S2666991920000238?via%3Dihub
Carinne Bruneton
E-MED@healthnet.org
<carinne.bruneton@hotmail.fr>
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